Child Health: Overview

1. Child Health: Overview Dr E Malek, Principal Specialist Department of Paediatrics, University of Pretoria, Witbank Hospital emalek@postino.up.ac.za

2. Acknowledgements • Dr Joy Lawn (Save the Children Fund) • DR Lesley Bamford (National DOH) • Dr Debbie Bradshaw (MRC NBD unit) • Prof T Duke (CICH, University of Melbourne) • Dr M Weber (WHO-CAH, Geneva) • Dr N McKerrow (PMB Hospital) • DR Macharia (UNICEF, Pretoria) • Dr N Rollins (UKZN) • DR C Sutton (MEDUNSA, Polokwane)

3. Outline • Global child health • Child Health in South Africa

4. Global Context (1) • Child Health Inequity • Causes of global child mortality • Child disability and development • Neonatal Health • Adolescent Health • Children in complex emergencies • Effect of poor child health on communities

5. Global Context (2) • Child Health in context of Maternal Health • International Conventions and child health • Evidence for effective intervention in reducing child mortality • Pathways to & principles of global child health

8. 10 million child deaths – Why? For these 4 causes, ~ 53% of deaths are malnourished children AIDS is much bigger proportion in Southern Africa. Source: Bryce J et al for the Child Health Epidemiology Reference Group. The Lancet, March 2005. As used in WHR 2005

9. Three causes account for 86% of all neonatal deaths 4 million newborn deaths – Why? 60 to 90% of neonatal deaths are in low birth weight babies, mostly preterm Source: Lawn JE, Cousens SN, Zupan J Lancet 2005. for 192 countriesbased on cause specific mortality data and multi cause modelled estimates. As used in World Health Report 2005

10. 200 1990 181 175 180 2000 Least reduction 160 3% 140 128 120 U5MR (deaths per 1000 births) 100 100 Greatest reduction 80 80 32% 64 58 60 53 45 44 38 37 40 20 9 6 0 Sub-Saharan South Asia Middle East & East Asia and Latin America CEE/CIS and Industrialized Africa North Africa Pacific & Caribbean Baltics countries Under five mortality rates: Trends from 1990-2000 Slide: Ngashi Ngongo Source: UNICEF, 2001

16. International Conventions • Declaration of Alma Ata: “Health for All by the year 2000” • UN Convention of the Rights of the Child (1990) • UN Millenium Development Goals (MDGs)

17. 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empowerment of women 4. Reduce child mortality by two thirds 5.Reduce MMR by three quarters 6. Combat HIV/AIDS, malaria and other diseases 7. Ensure environmental sustainability 8. Develop global partnerships for development Millennium Development Goals (MDGs)

21. Integrated Management of Chilldhood Illness (IMCI)

22. IMCI facility based usage in Bangladesh (Lancet, 2004)

23. WHO Initiatives to improve quality of care for children at hospital level: state of the art and prospects Martin Weber, Harry Campbell, Susanne Carai, Trevor Duke, Mike English, Giorgio Tamburlini 25th International Congress of Paediatrics, Athens, 25-30 August 2007

25. Standards of Hospital Care for Children: Hospital IMCI Evidence-Based Guidelines

27. Child Health in South Africa • Child Health Inequity • Causes of Child Mortality • Neonatal Health • National interventions for improving child health • Children’s Act (Amendment Bill: 2007) • Challenges

28. UNICEF remarks at opening of SA Child Health Priorities conference (Dec 2007, Durban)

29. Distribution of Resources

32. Slide: Ngashi Ngongo

34. South Africa progressto MDG 4 Under 5 mortality is increasing, related to HIV (73 000 a year) Neonatal mortality is probably static and accounts for ~30% of under five deaths (23,000 newborn deaths a year) Source: Lawn JE, Kerber K Opportunities for Africa’s Newborns. PMNCH, 2006

36. Causes of U5M Source: MRC 2003

38. Every Death Counts

40. Challenges: Health Service in South Africa

42. Child Mortality (1) • The National Burden of Disease study estimated just over half a million deaths of which • 106 000 were of children under the age of 5 years • A further 7800 were children aged 5-14 years. • An estimated 4564 deaths are from protein-energy malnutrition (Kwashiorkor) • In general, young babies are much more vulnerable than older • The cause of death patterns in the different age groups are very different.

43. Top twenty specific causes of death in childrenunder 5 years, South Africa 2000 (NBD)

44. Leading causes of death among infants under 1 year of age, South Africa 2000

45. Leading causes of death among infants under 1 year of age, South Africa 2000

46. Child Mortality (2) • The NBD study estimates that by the year 2000, • the Infant Mortality Rate had risen to 60 per 1000 live births and • the Under-5 mortality rate had risen to 95 per 1000. • This deterioration in child health occurred despite the introduction of free health care and nutrition programmes and was attributable to paediatric AIDS, commensurate with the high prevalence of HIV observed among pregnant women.

47. Leading causes of death among children aged 1-4 years, South Africa 2000

48. Leading causes of death among children aged 1-4 years, South Africa 2000

49. Child Mortality (3) • As children get older, external causes of death (eg. road traffic injuries and drowning) rise in importance. • This is particularly noticeable among boys who die in greater numbers than girls. This pattern becomes particularly marked among the 10 -14 year age group, where road traffic accidents is the leading cause of death. • Homicide and suicide feature in the top causes among the 10-14 year age group, homicide is the second leading cause of death.

50. HIV test ~ 54% tested 26% +ve 20% exposed Only 8% tested -ve HIV clinical stage ~ 58% staged of which half were Stages III & IV Child deaths in RSA - Why? Child PIP in Mpumalanga: ChPIP Data: Witbank Hospital had 2244 child admissions & 101 child deaths in 2006; overall case fatality rate 4.5; 31% of all deaths within 1st 24 hours of admission ChPIP Sites: 2004: Witbank 2006: Witbank & Barberton 2007: above plus 8 new sites 88% HIV if exclude neonatal Most deaths 1 month to 5 yrs * Source: WHO World health Statistics 2006 www.who.int